AccountId: 011433970860
ContactId: 26a388c3-0f87-4a8a-806d-429855538b20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459059 ms
Total Talk Time (AGENT): 217618 ms
Total Talk Time (CUSTOMER): 128014 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/26a388c3-0f87-4a8a-806d-429855538b20_20250401T15:12_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. I received an explanation of benefit statement, um, about a claim, about a claim that was um that was done on [PII] of this year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but it's for a, it's for a baby girl, [PII]. We do not have a baby girly. We do not have any children.
[AGENT][NEUTRAL] OK, um, uh, let me look into that for you. I
[AGENT][POSITIVE] I'd love to look into that for you. Do you mind if I get your first name real quick and a good call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. So, you need the callback number. It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And then what was your first name, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Miss [PII]. And do you have the policy number for your policy with us?
[CUSTOMER][NEUTRAL] Well, the policy number on the explanation of benefits statement is 0250.
[CUSTOMER][NEUTRAL] 489 3.
[AGENT][NEUTRAL] 93.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It has a claim number if you need to pull it up.
[AGENT][POSITIVE] Oh yeah, I would actually love that number. And what is that claim number?
[CUSTOMER][NEUTRAL] It's 357-406-9.
[AGENT][NEUTRAL] Perfect. And Ms. [PII], would you be able to verify for me, pretty please, your date of birth?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][POSITIVE] Wonderful. And
[AGENT][NEUTRAL] Real quick, I'm just gonna verify one more piece of information with you uh before I can pull up that claim number. If you could verify with me, please, the mailing address we have on file and the phone number.
[CUSTOMER][NEUTRAL] Um, it's under my husband's, uh [PII], and the, um, uh, address is [PII].
[AGENT][POSITIVE] Thank you. And um perfect. Let me dig into this real quick for you. Are you having a great day so far?
[CUSTOMER][NEUTRAL] I am. How about you?
[AGENT][POSITIVE] I'm doing wonderful. It's Tuesday. I started with a nice coffee, so I just feel like I'm living my best life.
[CUSTOMER][POSITIVE] That's so cool.
[CUSTOMER][POSITIVE] I'm glad.
[AGENT][NEUTRAL] Thanks and let's see alright so I did I was able to pull up the claim number you're talking about.
[AGENT][NEUTRAL] Let me take a look and see if there's something giving me a little more detail maybe in these notes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's saying the service was rendered on [PII], and it has a patient account number.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] And you don't have a daughter, correct? It's just you and your husband?
[CUSTOMER][NEUTRAL] Mm. No, ma'am. We have a son, an only son that I know, yes, that I know of.
[AGENT][NEUTRAL] OK. Oh, you have a son.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, OK. Um, is your son, was he?
[CUSTOMER][NEUTRAL] This says the claimant?
[CUSTOMER][NEUTRAL] The claimant is baby girl [PII], and the relationship to the insurer is the child.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. What is, um, if you don't mind, what is your son's date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Oh, OK. So it wouldn't have been this year that he was born. OK.
[CUSTOMER][NEUTRAL] No, no, he's [PII] old.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] OK, I definitely don't.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] What happened with this? I'm so sorry. I like, I wish I had magically all the answers on it. It looks like they put a dependent on your policy, um, as I see the same thing, baby girl [PII], but then it looks like they took her right off the policy and it shows that like she's not on it, she's lapsed. So I'm not sure if it was just a like.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] An error in entry and then they took it away, um.
[CUSTOMER][NEGATIVE] Like a mistake.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So what I'm seeing here on this is
[AGENT][NEGATIVE] That the explanation of benefits you got wasn't even for a claim for a baby girl. So I think it was like an error.
[AGENT][NEUTRAL] Um, in, in entry. So I'm not showing that this policy has any dependents active on it. I just see it has you and your husband.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. So I was
[AGENT][NEGATIVE] I would disregard that.
[CUSTOMER][NEUTRAL] I was worried that there was some charges, some charges or something attached to it.
[AGENT][NEUTRAL] No, it does look like um.
[AGENT][NEUTRAL] It looks like that claim.
[AGENT][NEUTRAL] Was I think it was placed in error like there was accidentally when they typed it in they had a dependent on the policy and then they lapsed it and then when that claim came in it was accidentally put on that dependent and not on the right person on the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I would go ahead and disregard that because I don't show we even have an active dependent on your policy and
[CUSTOMER][NEUTRAL] I think so.
[AGENT][NEUTRAL] I'm looking right now, it looks like.
[AGENT][NEUTRAL] Yeah, it looks like that claim actually was, um, I can't give you any details on it, but it was for your spouse and it will be processed under his name instead of baby girl [PII], so you'll get another explanation of benefits to the house.
[CUSTOMER][POSITIVE] Oh, OK. No problem. Thank you very much. And I hope you keep on hav[PII] a great day.
[AGENT][POSITIVE] Oh thank you you too and I'm glad we solved this mystery together.
[CUSTOMER][POSITIVE] Yes. Thank you very much. Have a great day. Bye-bye.
[AGENT][POSITIVE] Hey, it's my pleasure, Ms. [PII]. Thank you for calling AP and I hope you have a fantastic day.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Bye bye.